Download MBBS Ophthalmology PPT 33 Lid Disorder Lecture Notes

Disorders of Lid


Anatomy

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1. The skin
2. The subcutaneous areolar

tissue.

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3. The layer of striated muscle.
4. Submuscular areolar tissue.
5. Fibrous layer.
6. Layer of non-striated muscle

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fibres.

7. Conjunctiva.

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The eyelid Margin


GLANDS OF EYELIDS
1. Meibomian glands.

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q In tarsal plate arranged vertically.
qThese are modified sebaceous glands.
qTheir ducts open at the lid margin.
qTheir secretion constitutes the oily layer of tear film.

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2. Glands of Zeis.
qThese are also sebaceous glands which open into the follicles of

eyelashes.
3. Glands of Moll.

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qThese are modified sweat glands situated near the hair follicle.
qThey open into the hair follicles or into the ducts of Zeis

glands.

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4. Accessory lacrimal glands of Wolfring.
qThese are present near the upper border of the tarsal plate.

Edema of lids
Inflammatory edema

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Dermatitis, stye, insect bite, blepharitis
Passive edema
Renal disease, Cardiac failure,
Cavernous sinus thrombosis

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INFLAMMATIONS OF THE EYELIDS
Blepharitis
1. Anterior blepharits.
2. Posterior blepharitis.

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INFLAMMATIONS OF THE EYELIDS

Blepharitis

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INFLAMMATIONS OF THE EYELIDS
1. Anterior blepharits

Squamous

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Ulcerative

Treatment
Hot compress
Lid hygiene, cleaning with diluted baby shampoo

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Topical : antibiotic, steroids, tear substitute
Oral : Azithromycin 500 mg OD for 3 days.


INFLAMMATIONS OF THE EYELIDS

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Posterior blepharitis
Meibomian seborrhoea
Meibomianitis
Treatment:
Warm compress, lid hygiene & massage.

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Oral doxycyclin or minocyclin for 6 wks.


INFLAMMATION OF GLANDS OF LIDS

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Hordeolum externum or stye
Suppurative inflammation of gland of Zeis.
Hordeolum internum
Suppurative inflammation of meibomian gland
Chalazion

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Chronic inflammatory granuloma of meibomian gland.

STYE (EXTERNAL HORDEOLUM)
STYE (EXTERNAL HORDEOLUM)
It is an acute suppurative inflammation of gland of the Zeis.

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Causative organism commonly involved is Staphylococcus aureus.

Predisposing factors.
1. Refractive error
2. Blepharitis

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3. Habitual rubbing of eyelids
4. Diabetes Mellitus

Symptoms and signs
Pain

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Redness
Swelling
Watering
Other predisposing factors

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Treatment

1. Hot fomentation
2. Antibiotic eye ointment

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3. Anagesics
4. Oral antibiotics
5. Treatment of underlying cause

CHLAZION

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CHLAZION
It is also called a tarsal or meibomian cyst.

It is a chronic non-infective granulomatous inflammation of

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the meibomian gland.

Predisposing factors.
1. Refractive error
2. Blepharitis

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3. Habitual rubbing of eyelids
4. Diabetes Mellitus

Clinical course and complications
Complete spontaneous resolution may occur rarely.

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Occasionally, it may burst on the conjunctival side, forming a

fungating mass of granulation tissue.

Secondary infection leads to formation of hordeolum internum.

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Calcification may occur, though very rarely.
Malignant change into meibomian gland carcinoma may be seen

occasionally in elderly patients.

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Treatment
1. Conservative treatment.
2. Intralesional injection of long-acting steroid.
3. Incision and curettage.

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4. Diathermy.
INTERNAL HORDEOLUM

It is a suppurative inflammation of the meibomian gland

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associated with blockage of the duct.

It may occur as primary staphylococcal infection of the

meibomian gland or due to secondary infection in a chalazion

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(infected chalazion).

Treatment. It is similar to hordeolum externum, except
that, when the pus is formed, it should be drained by a

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vertical incision from the tarsal conjunctiva.

ANOMALIES IN POSITION OF THE

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LASHES AND THE LIDS
Blepharospasm
Trichiasis
Entropion
Ectropion

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Symblepharon
Ankyloblepharon
Blepharophimosis
Lagophthalmos
Ptosis.

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Blepharospasm
Involuntary, sustained and forcible closure of lids.
Essential blepharospasm
Reflex blepharospasm
Treatment: Botulinum toxin

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Facial denervation

Trichiasis
Misdirection of cilia, directed backwards to rub cornea.
Trachoma, blepharitis, scars, chemical burns, Steven-

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Johnson synd,

Treatment: Epilation, Electrolysis, Cryosurgery, Argon laser

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application.
Thank You